Propofol
- page 18

I wondered if anyone of you as RN's
use propofol? Only the anesthesia
people are using it. When anesthesia
is used they use propofol. We as Rn's are pushing the Demerol, Versed, Morpheine,...
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Can an RN bolus an intubated pt with an infusing propofol gtt in ICU? For example, let's say you have a gtt that has been going for a few hours and has been titrated to the lowest dose necessary to maintain adequate pt sedation, but the RN is going to do something that will agitate the pt...I have seen the RN bolus a few ccs of propofol before beginning. I questioned it the first time I saw it done because when I looked up the info in the drug guide I noticed immediately that it had no analgesic properties, but I was unaware of the controversy surrounding this medication. (and I was also a new tech at the time, so I didn't question much) Since then, I have seen other RNs do this as well.

I am now a new grad. I have read through ALL 19 pages of this thread, and I am hardly ignorant on the points made thus far, but I have yet to see any answer to this question.

I would guess, no. But I want to get some solid answer. I go back to work on Monday and I am going to clarify our facilities official policy on everything mentioned in this thread. Thanks in advance for your answers.

I work in the ER in a level one trauma and we use propofol all the time. We use it mainly o medicine pts that have been intubated. this is a great sedation. The only draw back back is it drops pressure. This is always put on a pump. I will bolus some if the pt is really fighting the vent and endagering themselves. This is usually less than 10cc though. As mentioned before the pressure will drop. I think this is a great drug. this is not considered a cons sed drug to use in procedures, this would be a wrong use of it. Why shouldn't nurses use this? only in CC areas though!

We use Fent and Versed for the patients we sedate, and CRNA's push the prop for their patients. (based on insurance, of course) I like it this way not, because I don't think I could do it, but the deeper sedation in some patients is exaggerated, and I feel more comfortable having the CRNA there to manage that. Thankfully the CRNA's that come in to our free standing GI Lab are more than happy to push propafol on our patients that are more difficult to sedate.

Anesthesia has been giving Propofol for about a year in our department. After watching several resp. depressions that included bagging, I know I don't want to give it. I trust they are well trained and want them to continue to take care of the patient.

In our ICU, we use propofol all the time d/t its short half life for neuro checks. All of these pts. are intubated. I have never had the experience of administering it to a pt. without a protected airway.

In the ICU, many times physicians will write orders to titrate Propofol as needed (at least they did when I worked in ICU). So technically, this could be considered a titration to maintain level of sedation during uncomfortable/difficult procedures on patients.

I was an ED nurse in a level I trauma center for 5 years, the OR for 3 years, and then the SICU in the same hospital for another 5 years before I became a crna. We used propofol daily without any issues. It is an extremely safe medicaion. I think it is crazy for any high functioning ED or ICU not to have propofol available or sedation, especially with severe trauma patients that require intubation! These nurses should be trained on the use of these drugs, and the use of the ramsey scale to be in compliance with sedation reguations. It is not that difficult to titrate a propofol drip, no more than a nipride or levoped drip. Titrate to the desired effect...if the patient becomes unstable, stabilize the patient. This is for patient safety and patient care. How safe it is for an anxious patient to be trying to dislodge his tube or trying to get out of bed with multiple traumatic injuries? I do not want to downplay the work of my profession, but let me say this... certain high functioning departments are prepared to handle almost any emergent situation if it arises with the use of certain sedative agents. The emergency physicians I have had e pleasure to work with intubated sometimes more than 10 patients a day. I am not talking about patients with stable VS, "Here take a few deep breaths," patient is relaxed, now intubate! I am talking about gashes through the throat, bullet wounds next to the trachea or anaphylaxis with a swelling throat on a 400+ pounder. You are trying to say that a patient who needs sedation with a crash cart next to him, on a monitor, with a physician neaby, and a nurse that pushes drugs through code situations left and right is not equipped enough to handle a patient that becomes extremely hypotensive, or even goes into Vtach or Vfib??? What can we do that this team cannot do? Really?
I thought I was high and mighty for a while after I graduated from the CRNA program, but I now realize that it only takes 2 1/2 more years of school and any nurse with some ICU experience can become a crna. It is simple as that! instead of being so cocky, we shoud be thankful that we can come out of a 2 1/2 year program making $75/hr. Keep your mouth shut before everyone realizes how overpaid we really are!
TLL, crna

I was an ED nurse in a level I trauma center for 5 years, the OR for 3 years, and then the SICU in the same hospital for another 5 years before I became a crna. We used propofol daily without any issues. It is an extremely safe medicaion. I think it is crazy for any high functioning ED or ICU not to have propofol available or sedation, especially with severe trauma patients that require intubation! These nurses should be trained on the use of these drugs, and the use of the ramsey scale to be in compliance with sedation reguations. It is not that difficult to titrate a propofol drip, no more than a nipride or levoped drip. Titrate to the desired effect...if the patient becomes unstable, stabilize the patient. This is for patient safety and patient care. How safe it is for an anxious patient to be trying to dislodge his tube or trying to get out of bed with multiple traumatic injuries? I do not want to downplay the work of my profession, but let me say this... certain high functioning departments are prepared to handle almost any emergent situation if it arises with the use of certain sedative agents. The emergency physicians I have had e pleasure to work with intubated sometimes more than 10 patients a day. I am not talking about patients with stable VS, "Here take a few deep breaths," patient is relaxed, now intubate! I am talking about gashes through the throat, bullet wounds next to the trachea or anaphylaxis with a swelling throat on a 400+ pounder. You are trying to say that a patient who needs sedation with a crash cart next to him, on a monitor, with a physician neaby, and a nurse that pushes drugs through code situations left and right is not equipped enough to handle a patient that becomes extremely hypotensive, or even goes into Vtach or Vfib??? What can we do that this team cannot do? Really?
I thought I was high and mighty for a while after I graduated from the CRNA program, but I now realize that it only takes 2 1/2 more years of school and any nurse with some ICU experience can become a crna. It is simple as that! instead of being so cocky, we shoud be thankful that we can come out of a 2 1/2 year program making $75/hr. Keep your mouth shut before everyone realizes how overpaid we really are!
TLL, crna